Sustainable Health Financing Research Articles

Cost–benefit analysis of mammography screening: the perspective of Nigerian healthcare providers

IntroductionThere is no national breast cancer screening implemented in Nigeria. The National Cancer Control Plan (NCCP) has a goal of making screening services and early detection of cancer available for...

Exploring sustainable health financing strategies in humanitarian settings: Challenges, innovations and efforts towards Achieving Universal Health Coverage

Sustainable health financing is critical in humanitarian settings to ensure that the most vulnerable populations have access to necessary healthcare services. In crises such as conflicts, natural disasters, or prolonged emergencies, healthcare systems are often destabilized, leading to significant challenges in providing adequate care. This review explores innovative financing mechanisms designed to support health services in these contexts, focusing on their potential to achieve Universal Health Coverage (UHC). Key challenges include limited funding, high out-of-pocket costs, and the uneven distribution of healthcare resources. In response, emerging models such as impact bonds, Islamic social finance, disaster risk insurance, and digital financial solutions offer new approaches to mobilizing resources and sustaining health interventions. These strategies are essential to bridging gaps in healthcare access, promoting equity, and strengthening the resilience of health systems. Policy recommendations highlight the importance of integrating emergency and routine health services, engaging communities, and enhancing coordination among stakeholders. Strengthening health financing mechanisms is vital for long-term improvements in health outcomes, especially in fragile settings. This research underscores the need for sustainable, inclusive policies that bolster health systems in the face of humanitarian crises.

Achieving universal health coverage inSub-Saharan Africa through the reformation of mental health financing

Insufficient financing is limiting mental health services for universal health coverage (UHC) in sub-Saharan Africa (SSA). Without ambitious steps to enhance mental health services, UHC will fall far below its historical agenda; however, adequate mental health financing could strengthen governments’ capacity to provide additional budgetary resources. This paper aims to identify potential strategies for more equitable and sustainable mental health financing in SSA. Using Uganda as a key example, we provide a contextual analysis and highlight current gaps. We draw parallels with successful countries and discuss recommendations for engagement from the global mental health community. This perspective focuses on health systems, mental disease burden, and macro-fiscal situation. Drivers of fiscal space for health indicate prospects to boost mental health budgets for socioeconomic development. Governments should conduct consistent mental health investment cases and expedite fiscal space for aggressive taxation to health reforms.

The Impact of Economic Factors on Public Health Expenditure in Türkiye: Principal Component Analysis Evaluation for the Period 2002-2022

This study analyzes the economic factors affecting public health expenditure in Türkiye from 2002 to 2022. The main objective is to identify the economic reasons for the decreasing share of public health expenditure in Gross Domestic Product (GDP). It examines macroeconomic variables such as GDP per capita, unemployment rate, labor force participation rate, consumer price index, tax revenue, and exchange rate using principal component analysis (PCA). The results show that GDP per capita, exchange rate, and tax revenue significantly impact public health expenditure, indicating a direct relationship between economic growth and health spending. The unemployment rate does not directly affect public health expenditure, while an increase in labor force participation rate can reduce it. This study underscores the importance of macroeconomic stability and effective economic policies for sustainable health financing in Türkiye. By using long-term data, it provides a comprehensive analysis of how economic factors impact health expenditure, distinguishing it from other studies in the literature. The findings emphasize that a healthy economy leads to increased public investment in health services.

The economic impact of a COVID-19 illness from the perspective of families seeking care in a private hospital in India.

The Covid-19 pandemic had a tremendous impact that caused significant morbidity, mortality, and financial stress for families. Our study aimed to determine the Out-of-pocket expenses and economic impact of a Covid-19 illness for households where patients were admitted to a private hospital in India. This was a cost-of-illness study from a tertiary care academic institute where adult patients diagnosed with COVID-19 from May 2020 to June 2021 were included. Patients with an admission of less than one day or who had any form of insurance were excluded. The clinical and financial details were obtained from the hospital information system and a cross-sectional survey. This was stratified across three clinical severity levels and two epidemiological waves. The final analysis included 4445 patients, with 73 % admitted in Wave 1 and 99 patients interviewed. For patients with severity levels 1, 2 and 3, the median admission days were 7, 8 and 13 days respectively. The total cost of illness (general category) was $934 (₹69,010), $1507 (₹111,403) and $3611 (₹266,930) and the direct medical cost constituted 66%, 77% and 91% of the total cost for each level respectively. Factors associated with higher admission costs were higher age groups, male gender, oxygen use, ICU care, private admission, increased duration of hospital stay and Wave 2. The median annual household income was $3247 (₹240,000) and 36% of families had to rely on more than one financial coping strategies, loans with interest being the commonest one. The lockdown period affected employment and reduced income for a considerable proportion of households. A Covid admission of higher severity was a significant financial burden on families. The study reaffirms the need for collaborative and sustainable health financing systems to protect populations from hardships.$-US Dollar; ₹- Indian Rupees.

Tobacco Tax Policy and Its Impact on Health Finance in Different Countries: A Systematic Review

The consumption of detrimental products, such as cigarettes, has a significant impact on health financing. Smoking is a detrimental practice that has negative effects on health, and the medical expenses linked to smoking-related ailments are considerable. In response, many countries have established cigarette excise laws with the aim of mitigating the adverse effects of smoking on public health and health financing. The implementation of cigarette excise taxes has resulted in a notable reduction in cigarette consumption, an increase in government revenue, and the funding of health programmes. This study aimed to enhance the understanding of the role of tobacco excise laws in promoting sustainable health financing. This study involved the review of 8 papers, and it was conducted following the guidelines of PRISMA-P, 2015 for systematic reviews. A comprehensive literature search was conducted utilizing multiple databases, including PubMed, EBSCO, and ScienceDirect. The tobacco excise management policy has generally aligned with its intended objectives. However, certain aspects, such as reducing consumption, allocation amounts, tariff patterns, and burdens, have yet to be fully effective. Therefore, it is necessary to implement strategic measures to enhance adequacy, such as increasing the pattern of excise tariffs and allocations and ensuring accountability and transparency in implementation.

Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review

BackgroundUniversal Health Coverage (UHC) has received much attention and many countries are striving to achieve it. The Southeast Asian region, in particular, comprises many developing countries with limited resources, exacerbating challenges around attaining UHC. This paper aims to specifically explore the health financing challenges these countries face in achieving UHC via a systematic review approach and formulate recommendations that will be useful for policymakers.MethodsThe systematic review followed the guidelines as recommended by PRISMA. The narrative synthesis approach was used for data synthesis, followed by identifying common themes.ResultsThe initial search returned 160 articles, and 32 articles were included after the screening process. The identified challenges in health financing towards achieving UHC in the Southeast Asian region are categorised into six main themes, namely (1) Unsustainability of revenue-raising methods, (2) Fragmented health insurance schemes, (3) Incongruity between insurance benefits and people’s needs, (4) Political and legislative indifference, (5) Intractable and rapidly rising healthcare cost, (6) Morally reprehensible behaviours.ConclusionsThe challenges identified are diverse and therefore require a multifaceted approach. Regional collaborative efforts between countries will play an essential role in the progress towards UHC and in narrowing the inequity gap. At the national level, individual countries must work towards sustainable health financing strategies by leveraging innovative digital technologies and constantly adapting to dynamic health trends.RegistrationThis study is registered with PROSPERO, under registration number CRD42022336624.

Dynamics of Health Financing among the BRICS: A Literature Review

Despite economic progress, government efforts, and increased healthcare investments, health deprivation continues to persist in the countries of Brazil, Russia, India, China, and South Africa (BRICS). Hence, addressing the growing demand for health financing in a sustainable way and adopting unique approaches to healthcare provision is essential. This paper aims to review publications on the existing health financing systems in the BRICS countries, analyze the core challenges associated with health financing, and explore potential solutions for establishing a sustainable health financing system. This paper adhered to the PRISMA guidelines when conducting the keyword search and determining the criteria for article inclusion and exclusion. Relevant records were obtained from PubMed Central using nine keyword combinations. Bibliometrics analysis was carried out using R software (version 4.1.3), followed by a comprehensive manual narrative review of the records. BRICS countries experienced increased health expenditure due to aging populations, noncommunicable diseases, and medical advancements. The majority of this increased spending has come from out-of-pocket payments, which often lead to impoverishment. Due to limited fiscal capabilities, administrative difficulties, and inefficiency, providing comprehensive healthcare through public funding alone has become exceedingly difficult for these countries. Public-private partnerships are essential for achieving sustainable health financing and addressing challenges in healthcare provision.

Determinants of enrollment in community based health insurance program among households in East Wollega Zone, west Ethiopia: Unmatched case-control study.

Ethiopia has launched a community-based health insurance (CBHI) since 2011, which is an innovative financing mechanism to enhance domestic resource mobilization and sustainable health financing. This study assessed determinants of CBHI enrollment among HHs (households) of East Wollega, Ethiopia, 2022. Community based unmatched 1:2 case-control study design was conducted between Jan 7and Feb 5/2022 among 428 HHs (144 cases and 284 controls). Cases were selected from HHs who registered for CBHI and currently using CBHI. Controls were from those who do not registered for CBHI membership. Data collected using a semi-structured, interview administered questionnaire. Multivariable logistic regression with SPSS version 25 was employed for analysis and variables were declared statistical significant association at p-value < 0.05, 95% CI. Data from 428 (144 cases and 284 controls to CBHI) were collected; a response rate of 98.8%. Statistically lower odds of CBHI enrollment was observed among HHs who have poor knowledge [AOR = 0.48 (95% CI:0.27, 0.85)], perceived not respectful care [AOR = 0.44 (95% CI :0.24, 0.81)], unavailability of laboratory services [AOR = 0.37(95% CI:0.21, 0.66)], inappropriate time of premium payment [AOR = 0.31(95% CI:0.18, 0.52)]. In addition, medium wealth status category [AOR = 0.11(95% CI: 0.03, 0.45)]. Higher odd of CBHI enrollment observed among who have formal education [AOR = 2.39(95% CI: 1.28, 4.48)]. Educational level, knowledge, time of membership payment, laboratory test availability, perception of respectful care and wealth status were significant determinants of CBHI enrollment status. Hence, the responsible bodies should discuss and decide with community on the appropriate time of premium payment collection, and enhance community education on CBHI benefit package.

The role of community-based approaches in achieving universal health coverage: addressing the Nigerian narrative.

Universal health coverage (UHC) is aimed at ensuring that individuals and communities have affordable access to essential health care services without facing financial hardship. Achieving UHC and the third sustainable development goal of the United Nations requires that health systems transition from a vertical, top-down, curative approach toward one that puts people at the core of health care services, such as community-centered health interventions. Nigeria operates a decentralized health care system with the least focus on primary health care, making access to quality, and affordable health care for several citizens a challenge as the major percentage of the Nigerian population relies on primary health care services. The limited number of health care workers, the poor economic state, the inadequate health financing structures and high illiteracy rates have led to challenges such as low health service availability, hesitancy to utilize health interventions, high out-of-pocket expenditure rates, and health misinformation. These can be effectively tackled at the community level by revamping primary health care services, adequate and sustainable health financing, establishing Ward Development Committees, and the involvement of community stakeholders in health policy implementation. Employing such community-based approaches will ensure continuous progress of the Nigerian health care system toward UHC.

Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff.

Digital interventions for health financing, if implemented at scale, have the potential to improve health system performance by reducing transaction costs and improving data-driven decision-making. However, many interventions never reach sustainability, and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. Respondents appreciated IMIS's intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage.

Household Catastrophic Health Care Expenditure: Evidence on the Effects of Out-of-pocket Health Care Payments on Household Income in East African Region

Out Of Pocket Payments (OOPP) refers to the amount of money a patient pays for medical expenses that are not covered by a health insurance plan (National Cancer Institute, 2022). The World Health Organization (WHO) defines OOPP as the individuals’ direct payments to healthcare providers at the time of service use (Kalantari, 2012). Developing countries are exposed to considerable socio-economic vulnerabilities. Catastrophic out-of-pocket spending has adverse effects on individual and household income, especially where policies on healthcare financing does not favor the poor. Heath care funding and the quality of healthcare outcomes in development are inseparable. The World Health Organization Assembly resolution of 2005 on universal coverage and sustainable health financing, the Paris Declaration of 2001 on greater Investments in the Health Sector, Health Insurance and Financing, and the Sustainable Development Goal number 1 on ending all forms of poverty forms the basis of this study. African Governments committed through the Abuja Declaration, to allocate and spend at least 15 percent of government funds of their National GDP on health. In June 2015, Countries in the East African Community concurrently released their National budgets for the Financial Years 2015/2016. None of the countries had fulfilled the Abuja declaration promise on healthcare investment in East African Community. This study examined how different countries in East Africa have invested in healthcare and the state of out-of-pocket spending on household income. Related literature review will be analyzed, and conclusions and the way forward in relation to household healthcare spending in East African Countries will be discussed.

A Review of Recent Developments and Future Challenges in the Implementation of Universal Health Coverage Policy Framework in Some Countries

Global attention has recently converged on the need for countries to achieve universal health coverage (UHC), which aims to guarantee that all persons are able to access needed and effective healthcare without facing financial ruin by using services. In the attempt to move towards UHC, several low- and middle-income countries are developing more sustainable revenue sources, expanding pooling arrangements and employing more efficient and sustainable purchasing strategies. Their experiences represent a growing evidence of the application of mandatory (social), private and community-based health insurance in low- and middle-income countries and their potential contribution to UHC. UHC reforms are an inherently political process, and public health advocates will need to do more to promote not only the health benefits of public health interventions but also the economic and political benefits too. Crucially, as UHC continues to be championed and rolled out globally, all people working in global health need to reinforce the importance of including the full scope of public health in health system reforms; only then can the full potential of UHC be realized—a true reduction in health inequities. However, implementation of a UHC is not an easy phenomenon, rather it needs proper design of a good health insurance system by integrating both the public and private health care providers. The influence of good governance and a sustainable health financing system is fundamental to establish UHC in the developing countries. This review Paper encompasses recent developments and future challenges in the implementation of Universal Health Coverage Policy framework in some countries.

Revisiting the issue of access to medicines in Africa: Challenges and recommendations

AbstractBackgroundAccess to safe, effective, affordable, and quality medicines is an essential component of the right to health and is also one of the targets in the global development agenda. In this review article, we extensively discuss the challenges and issues surrounding access to medicines in the African region as well as provides recommendations for ensuring medicines security on the continent.MethodsWe conducted narrative review with the use of data reported in published literature, reports, and grey literature available in African countries on topics pertaining access to medicines. The authors also snowballed further data to gather information for this review and narrative synthesis was conducted.ResultsAfrica faces a double burden of infectious and non‐communicable diseases and the need for effective universal access to medicines cannot be deemphasized. However, access to medicines on the continent is not without issues and challenges. Some of which are the high burden of infectious diseases and non‐infectious diseases, limited pharmaceutical industries and high costs of raw materials, overdependence on countries abroad for medicines, poor supply chain systems, lack of government investment in the pharmaceutical sector, unfavourable manufacturing conditions, limited health workforce, lack of sustainable health financing mechanisms, lack of infrastructures and technical know‐how, low investment on research and development, and circulation of fake and counterfeit medicines among others.ConclusionThis review reifies that access to medicines in Africa faces numerous challenges and it emphasizes the urgent need to address these issues as the continent geared towards strengthening its health systems for universal health coverage.

COVID-19 and Health Systems Functioning in Sub-Saharan Africa Using the "WHO Building Blocks": The Challenges and Responses.

Sub-Saharan Africa (SSA) has made major progress in improving access to health care over the past three decades. Despite efforts made toward achieving universal health coverage, the health systems of countries in the sub-region are inundated by a myriad of challenges that have become more virulent amid the COVID-19 pandemic. This paper discusses the health systems challenges and responses in SSA amidst the COVID-19 using the World Health Organization's (WHO) building blocks of health systems functioning. Long-lasting abysmal health system financing and insufficient government investment in SSA pose major challenges to the effective health systems functioning amid the COVID-19 pandemic. This situation also makes it difficult for the health system to meet the demands of the COVID-19 pandemic and at the same time, cater for other essential health services. Countries in SSA must prioritize the reformation of their health systems through effective health system policy development and implementation, human resources development, training, service delivery, governance and regulation, and sustainable health financing.

Sustainable health financing: Health-threatening products

The article's abstract is not available.

Catastrophic health expenditure and impoverishment in Vietnam: Evidence from national Household Living Standards Surveys 2008–2018

One of the strategic objectives of the Vietnamese government in achieving universal health coverage (UHC) is to develop a sustainable, equitable, and effective health financing system. This study aimed to examine the incidence and intensity of catastrophic health expenditure (CHE) and impoverishment in Vietnam at different thresholds of expenditure. The data were obtained from six national representative Household Living Standards Surveys from 2008 to 2018. We found that the incidence and intensity of CHE declined significantly over study years. Additionally, we found a substantial reduction in the incidence and intensity of medical impoverishment in Vietnam. The increase in the poverty gap in 2012 and 2014 was because non-poor households became poor after out-of-pocket (OOP) health payments. However, the rise in poverty gaps in 2008, 2010, 2016 and 2018 was attributable to the worsening state of existing poor households after healthcare payments. In addition, we found that the CHE rate and impoverishment were more concentrated in the poor quintile groups. Furthermore, we found that the Red River Delta had the highest CHE rate, whereas the Northern Midland region experienced the strongest poverty impact of OOP payments. Generally, in Vietnam, the health financing system has had no considerable success in reducing inequality across quintiles and regions. Finally, our findings revealed that health insurance showed positive impacts on households’ financial protection against CHE and impoverishment, after enacting both the first Health Insurance Law in 2009 and the Revised Health Insurance Law in 2015. The results suggest that the health insurance scheme should be reviewed to continue reducing CHE and impoverishment, promoting equity and enhancing the performance of the health financing system in Vietnam.

Comment on “Sustainable Health Financing for COVID ‐19 Preparedness and Response in Asia and the Pacific”

Kwon and Kim (2022) summarize the impact of COVID-19 on health and the economy in Asia and the Pacific and how countries have responded to the challenge. In addition, they propose ways to strengthen the health care system so that governments can better prepare for a pandemic. This is a timely study because many countries worldwide are still struggling with dealing with the COVID-19 pandemic successfully. The health care systems in the region are significantly different, and the pandemic response varies from country to country. As a result, there are ample opportunities to learn from the experiences of other countries, and Kwon and Kim (2022) do an excellent job of emphasizing them under a unified framework. I like Kwon and Kim's (2022) paper for four reasons. First, this paper is comprehensive and examines various aspects of the health care system that can increase resilience to a pandemic. In particular, Kwon and Kim (2022) highlight the importance of investing in financing, service delivery, and governance and provide some examples of how governments can do so. Second, it covers many countries in Asia and the Pacific with different income levels, which allows all countries to learn from other countries that share similar health care systems and challenges. Third, Kwon and Kim (2022) emphasize that pandemic “preparedness” is vital for a resilient health care system and urge governments to reassess existing arrangements and prepare for future crises. I agree with this. Finally, I find the discussion of “mobilizing private sector providers” stimulating and valuable. Private sector providers often play a crucial role in Asia and the Pacific, so it is essential to mobilize them during a pandemic. This is also a big problem in Japan, where I live. The rest of this comment will focus on this issue. Mobilizing private sector providers may not be easy. As Kwon and Kim (2022) state, many countries in Asia and the Pacific – such as the Republic of Korea, Japan, the Philippines, Cambodia, India, Indonesia, and Bangladesh – rely on private sector providers. In contrast, Thailand, Bhutan, Timor-Leste, Sri Lanka, and the Pacific Island nations rely primarily on public providers. If the health care system relies mainly on public sector providers, mobilizing providers in an emergency would be relatively easy. However, mobilizing private sector providers may not be straightforward, as the treatment of COVID patients can be costly and not financially attractive. For example, providers must bear the initial setup costs to prevent infection and purchase specialized equipment such as ventilators and extracorporeal membrane oxygenation machines. Treating COVID patients also require a significant number of nursing staff. The need to separate COVID and non-COVID patients may reduce bed turnover, and COVID patients may require longer hospital stays. Health care providers are also at risk of losing future patients if they refer non-COVID patients to other hospitals that do not accept COVID patients. Governments may mobilize private sector providers in two ways. The first is to increase provider payments to cover the higher cost of treating COVID patients. Kwon and Kim (2022) do a great job of discussing several such attempts in the region. For example, Japan doubled provider payments for treating critically ill COVID patients in intensive care since April 2020 (tripled since May 2020). More recently, in December 2020, the government began paying up to US$142,000 per bed to cover the initial setup costs and fixed costs to treat COVID patients. Unfortunately, however, these financial incentives did not appear to be sufficient to secure beds for COVID patients. In Japan, less than 1% of all hospital beds are available for COVID patients, significantly lower than in other countries such as the USA (11%) and the United Kingdom (23%). Kwon and Kim (2022) also discuss government responses in Bangladesh, India, and Korea. Like Japan, some of these countries have raised provider payments for treating COVID patients. Others have subsidized hospitals to cover the fixed costs of accepting COVID patients. A further discussion of better-combining provider payments and subsidies would help us prepare for future pandemics. A clear alternative to higher provider payments is the command-and-control approach. As Kwon and Kim (2022) state, countries can introduce legislation that mandates providers to accept COVID patients. This does help mobilize private sector providers and mitigate bed shortages in emergencies, but it may create another set of problems. For example, determining the amount and duration of compensation for private providers may not be easy, as the impact and length of the pandemic are unpredictable. Kwon and Kim (2022) discuss Thailand's approach, where private hospitals must take COVID patients when COVID patients at public hospitals exceed a threshold. This approach makes sense, and it would be further enlightening if Kwon and Kim (2022) could discuss similar or different regulatory strategies that other countries in the region have implemented.

Comment on “Sustainable Health Financing for COVID ‐19 Preparedness and Response in Asia and the Pacific”

Comment on “Sustainable Health Financing for <scp>COVID</scp> ‐19 Preparedness and Response in Asia and the Pacific”

Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis.

Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE. This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified. Among the 19 studies included, an average of 43.3% (95% CI 36.7-50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex. The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients.